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Case
#51 "Executive Decision"
by Charlene Babcock Irvin, MD
 A
61 y/o male presents in the early morning
directly from the airport where he had just
flown in from Atlanta. He is with his wife
who accompanied him on the business trip. He
is worried he has suffered a mini-stroke. He
had fallen asleep on the overnight flight,
but when he woke up (his wife estimates he
was sleeping for about one hour) he couldn’t
move his right side. Initially he thought
his arm and leg had fallen asleep, but when
the symptoms weren’t getting better and he
realized he couldn’t talk, he became more
alarmed. By the time the stewardess answered
the call button, his symptoms were
improving. All his symptoms had resolved 15
minutes after he woke up (longest potential
time was 75 min of symptoms, if the symptoms
started just as he fell asleep). Now he is
back to normal, and wants to get checked
out. He did check his glucose on the plane
after symptoms resolved, and it was 120.
PMH: Non-insulin dependant diabetes and
hypertension. He has never had a stroke or
TIA.SH: He is an executive for a large
international company. No history of
smoking.
FH: Negative for strokes in his family
ROS: No fever, chills, shortness of breath,
vomiting, diarrhea, pain anywhere.
Physical Exam: BP 180/100, HR=70, RR=18,
Temp = afebrile
HEENT: No bruits, unremarkable
Heart: RRR no murmurs
Lungs: Clear
ABD: Normal
1. What is his risk for a stroke in the
next two days?
2. How should you manage the blood
pressure? Any position to recommend?
3. What medication should you prescribe?
4.Should you sign him out AMA?
Click here for answers and to respond
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